经输尿管软镜取石术与经皮肾镜取石术治疗肾结石的有效性和安全性的系统评价_《中国循证医学杂志》

作者：

牛超 , 廖邦华 , 罗德毅 ,  王坤杰

四川大学华西医院泌尿外科（成都 610041）;

关键词：

肾结石经输尿管软镜取石术经皮肾镜取石术系统评价 Meta分析随机对照试验

DOI：

10.7507/1672-2531.20130153

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价经输尿管软镜取石术与经皮肾镜取石术治疗肾结石的有效性和安全性。
方法　计算机检索MEDLINE、EMbase、The Cochrane Library、CNKI、CBM、VIP及WanFang Data（1990.1～2012.8），全面收集有关经输尿管软镜取石术和经皮肾镜取石术比较治疗肾结石的临床试验。由两位研究者独立进行文献筛选、资料提取和评价纳入研究的方法学质量后，采用RevMan 5.1软件进行Meta分析。
结果　纳入8篇研究，均为非随机对照试验，共计536例患者。Meta分析结果显示：经输尿管软镜取石术的结石清除率低于经皮肾镜取石术［OR=0.26，95%CI（0.15，0.46）］，而在术后发热［OR=0.1，95%CI（0.42，3.35）］、是否输血［OR=0.17，95%CI（0.03，1.00）］、住院时间［MD= –1.25，95%CI（–1.54，–0.96）］方面则优于经皮肾镜取石术。
结论　现有证据显示，在结石清除率方面，经输尿管软镜取石术低于经皮肾镜取石术，而在并发症、住院时间、医疗费用方面，经输尿管软镜取石术则优于经皮肾镜取石术。

引用本文： 牛超,廖邦华,罗德毅,王坤杰. 经输尿管软镜取石术与经皮肾镜取石术治疗肾结石的有效性和安全性的系统评价. 中国循证医学杂志, 2013, 13(7): 868-874. doi: 10.7507/1672-2531.20130153 复制

1.	吴孟超, 吴在德, 主编. 黄家驷外科学. 第7版. 北京: 人民卫生出版社, 2008: 1432-1980.
2.	石美鑫, 主编. 实用外科学. 第2版. 北京: 人民卫生出版社, 2005: 2405-2410.
3.	岐宏政, 沈鹏飞, 刘勇, 等. 肾镜取石术与开放手术治疗肾结石的系统评价. 中华腔镜泌尿外科杂志(电子版), 2009, 3(5): 382-388.
4.	程跃, 刘冠琳, 输尿管软镜治疗上尿路结石的现状与展望. 现代实用医学, 2012, 24(6): 603-606.
5.	刘鸣, 主编. 系统评价、META-分析设计与实验方法. 第1版. 北京: 人民卫生出版社, 2011: 98-117.
6.	Hyams ES, Shah O. Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol, 2009, 182(3): 1012-1017.
7.	Akman T, Binbay M, Ozgor F, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int, 2012, 109(9): 1384-1389.
8.	Akman T, Binbay M, Ugurlu M, et al. Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones: a matched-pair analysis. J Endourol, 2012, 26(6): 625-629.
9.	Bozkurt OF, Resorlu B, Yildiz Y, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol, 2011, 25(7): 1131-1135.
10.	Knoll T, Jessen JP, Honeck P, et al. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol, 2011, 29(6): 755-759.
11.	Chung BI, Aron M, Hegarty NJ, et al. Ureteroscopic versus percutaneous treatment for medium-size (1-2-cm) renal calculi. J Endourol, 2008, 22(2): 343-346.
12.	高小峰, 周铁, 陈书尚, 等. 输尿管软镜碎石与微创经皮肾取石术治疗肾盏结石的对比研究. 中华腔镜泌尿外科杂志, 2007, 1(2): 69-72.
13.	施小东, 程跃, 邱中笑, 等. 电子输尿管软镜碎石术治疗肾结石疗效观察. 现代实用医学, 2012, 22(9): 1018-1019.
14.	Okhunov Z, Friedlander JI, George AK, et al. STONE Nephrolithometry: Novel Surgical Classification System for Kidney Calculi. Urology, 2013, 21(8): 659-694.
15.	Yili L, Yongzhi L, Ning L, et al. Flexible ureteroscopy and holmium laser lithotripsy for treatment of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease. Urol Res, 2012, 40(1): 87-91.
16.	Falahatkar S, Khosropanah I, Allahkhah A, et al. Open surgery, laparoscopic surgery, or transureteral lithotripsy—which method? Comparison of ureteral stone management outcomes. Journal of Endourology, 2011, 25(1): 31-34.
17.	Agarwal M, Agrawal MS, Jaiswal A, et al. Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL). BJU International, 2011, 108(8): 1346-1349.
18.	Multescu R, Geavlete B, Georgescu D, et al. Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: A critical comparison. J Endourol, 2010, 24(1): 17-21.
19.	Perlmutter AE, Talug C, Tarry WF, et al. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology, 2008, 71(2): 214-217.
20.	Molimard B, Al-Qahtani S, Lakmichi A, et al. Flexible ureterorenoscopy with holmium laser in horseshoe kidneys. Urology, 2010, 76(6): 1334-1337.
21.	El-Nahas AR, Ibrahim HM, Youssef RF, et al. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int, 2012, 110(6): 898-902.
22.	马建伟, 程跃. 输尿管软镜治疗上尿路结石新进展. 临床泌尿外科杂志, 2012, 27(5): 398-400.
23.	Rippel CA, Nikkel L, Lin YK, et al. Residual fragments following ureteroscopic lithotripsy: incidence and predictors on postoperative computerized tomography. J Urol, 2012, 188(6): 2246-2251.

1. 吴孟超, 吴在德, 主编. 黄家驷外科学. 第7版. 北京: 人民卫生出版社, 2008: 1432-1980.
2. 石美鑫, 主编. 实用外科学. 第2版. 北京: 人民卫生出版社, 2005: 2405-2410.
3. 岐宏政, 沈鹏飞, 刘勇, 等. 肾镜取石术与开放手术治疗肾结石的系统评价. 中华腔镜泌尿外科杂志(电子版), 2009, 3(5): 382-388.
4. 程跃, 刘冠琳, 输尿管软镜治疗上尿路结石的现状与展望. 现代实用医学, 2012, 24(6): 603-606.
5. 刘鸣, 主编. 系统评价、META-分析设计与实验方法. 第1版. 北京: 人民卫生出版社, 2011: 98-117.
6. Hyams ES, Shah O. Percutaneous nephrostolithotomy versus flexible ureteroscopy/holmium laser lithotripsy: cost and outcome analysis. J Urol, 2009, 182(3): 1012-1017.
7. Akman T, Binbay M, Ozgor F, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int, 2012, 109(9): 1384-1389.
8. Akman T, Binbay M, Ugurlu M, et al. Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones: a matched-pair analysis. J Endourol, 2012, 26(6): 625-629.
9. Bozkurt OF, Resorlu B, Yildiz Y, et al. Retrograde intrarenal surgery versus percutaneous nephrolithotomy in the management of lower-pole renal stones with a diameter of 15 to 20 mm. J Endourol, 2011, 25(7): 1131-1135.
10. Knoll T, Jessen JP, Honeck P, et al. Flexible ureterorenoscopy versus miniaturized PNL for solitary renal calculi of 10-30 mm size. World J Urol, 2011, 29(6): 755-759.
11. Chung BI, Aron M, Hegarty NJ, et al. Ureteroscopic versus percutaneous treatment for medium-size (1-2-cm) renal calculi. J Endourol, 2008, 22(2): 343-346.
12. 高小峰, 周铁, 陈书尚, 等. 输尿管软镜碎石与微创经皮肾取石术治疗肾盏结石的对比研究. 中华腔镜泌尿外科杂志, 2007, 1(2): 69-72.
13. 施小东, 程跃, 邱中笑, 等. 电子输尿管软镜碎石术治疗肾结石疗效观察. 现代实用医学, 2012, 22(9): 1018-1019.
14. Okhunov Z, Friedlander JI, George AK, et al. STONE Nephrolithometry: Novel Surgical Classification System for Kidney Calculi. Urology, 2013, 21(8): 659-694.
15. Yili L, Yongzhi L, Ning L, et al. Flexible ureteroscopy and holmium laser lithotripsy for treatment of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease. Urol Res, 2012, 40(1): 87-91.
16. Falahatkar S, Khosropanah I, Allahkhah A, et al. Open surgery, laparoscopic surgery, or transureteral lithotripsy—which method? Comparison of ureteral stone management outcomes. Journal of Endourology, 2011, 25(1): 31-34.
17. Agarwal M, Agrawal MS, Jaiswal A, et al. Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL). BJU International, 2011, 108(8): 1346-1349.
18. Multescu R, Geavlete B, Georgescu D, et al. Conventional fiberoptic flexible ureteroscope versus fourth generation digital flexible ureteroscope: A critical comparison. J Endourol, 2010, 24(1): 17-21.
19. Perlmutter AE, Talug C, Tarry WF, et al. Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology, 2008, 71(2): 214-217.
20. Molimard B, Al-Qahtani S, Lakmichi A, et al. Flexible ureterorenoscopy with holmium laser in horseshoe kidneys. Urology, 2010, 76(6): 1334-1337.
21. El-Nahas AR, Ibrahim HM, Youssef RF, et al. Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20 mm. BJU Int, 2012, 110(6): 898-902.
22. 马建伟, 程跃. 输尿管软镜治疗上尿路结石新进展. 临床泌尿外科杂志, 2012, 27(5): 398-400.
23. Rippel CA, Nikkel L, Lin YK, et al. Residual fragments following ureteroscopic lithotripsy: incidence and predictors on postoperative computerized tomography. J Urol, 2012, 188(6): 2246-2251.

《中国循证医学杂志》

经输尿管软镜取石术与经皮肾镜取石术治疗肾结石的有效性和安全性的系统评价

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《中国循证医学杂志》

经输尿管软镜取石术与经皮肾镜取石术治疗肾结石的有效性和安全性的系统评价

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